F-SHRP Waiver Managed Long Term Care (MLTC) Amendment - August 2012

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DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
Administrator
Washington DC 20201

August 31, 2012

Nirav R. Shah, M.D.
Commissioner
New York State Department of Health
Corning Tower
Governor Nelson A. Rockefeller Empire State Plaza
Albany, NY 12237

Dear Dr. Shah:

This letter is to inform you that the Centers for Medicare & Medicaid Services (CMS) is granting your request to amend New York´s Medicaid section 1115 Demonstrations, entitled "Partnership Plan" (1 l-W-00114/2), and "Federal-State Health Reform Partnership (F-SHRP)" (1l-W- 00234/2). We are approving the amendment to the Demonstrations under the authority of section 1115(a) of the Social Security Act, and the amendment is effective from the date of this letter through the end of the Demonstrations.

This award is a partial response to the letter sent April 13, 2011, by Mr. Jason Helgerson, in which Mr. Helgerson requested several changes to the Partnership Plan and F-SHRP Demonstrations. At this time, CMS is approving the state´s request to establish the managed long-term care (MLTC) program under the Demonstrations, which will expand mandatory Medicaid managed care enrollment to dually-eligible individuals over age 21 who receive community-based long-term care services in excess of 120 days and provide dually-eligible individuals age 18 - 21, as well as nursing home eligible non-dual individuals age 18 and older, the option to enroll in the MLTC program. In addition, this amendment permits the state to expand eligibility to ensure continuity of care for individuals who are moving from an institutional long-term care setting to receive community-based long term care services through the managed long-term care program.

We look forward to continuing our discussions with your staff on New York´s request to transition the state´s Section 1915(c) waiver, the Long-Term Home Health Care Program, into the MLTC program once the necessary Section 1915(c) waiver amendment has been approved.

The CMS approval of the Partnership Plan and F-SHRP amendments is conditioned upon continued compliance with the enclosed sets of Special Terms and Conditions (STCs) defining the nature, character, and extent of anticipated Federal involvement in the projects. The award is subject to our receiving your written acknowledgement of the awards and acceptance of these STCs within 30 days of the date of this letter.

Copies of the revised STCs and expenditure authorities are enclosed. The waivers for the Demonstrations are unchanged by this amendment, and remain in force.

Your project officer for this demonstration is Ms. Jessica Schubel. She is available to answer any questions concerning your section 1115 demonstration and this amendment. Ms. Schubel´ s contact information is as follows:

  • Centers for Medicare & Medicaid Services
    Center for Medicaid and CHIP Services
    Mail Stop S2-01-16
    7500 Security Boulevard
    Baltimore, MD 21244-1850
    Telephone: (410) 786-3032
    Facsimile:   (410) 786-5882
    E-mail:       Jessica.Schubel@cms.hhs.gov

Official communication regarding program matters should be sent simultaneously to Ms. Schubel and to Mr. Michael Melendez, Associate Regional Administrator in our New York Regional Office. Mr. Melendez´s contact information is as follows:

  • Centers for Medicare & Medicaid Services
    New York Regional Office
    Division of Medicaid and Children´s Health
    26 Federal Plaza
    New York, New York 10278

I am pleased that we were able to reach a satisfactory resolution to your request, and look forward to working with you and your staff as you seek to redesign the New York Medicaid program.

If you have questions regarding the terms of this approval, please contact Ms. Victoria Wachino, Director, Children and Adults Health Programs Group at (410) 786-5647.

Sincerely,

Marilyn Tavenner
Acting Administrator

Enclosures

cc: Cindy Mann, Director, Center for Medicaid and CHIP Services
      Victoria Wachino, Director, Children and Adults Health Programs Group
      Michael Melendez, ARA, New York Regional Office
      Jason Helgerson, Deputy Commissioner, New York Department of Health
      Vallencia Lloyd, Office of Health Insurance Programs, New York Department of Health